This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.

"Recontrolling pertussis": a phrase we shouldn't have to hear

The word is going out that a lot of people need to get a pertussis booster shot Pertussis, more commonly known as whooping cough, is a bacterial infection that is very dangerous and sometimes fatal in young infants, whose immune systems are too immature to protect them. The only way to protect the very young is to make sure those around them -- parents, siblings, other relatives, and day care providers -- are vaccinated. Many adults were vaccinated as children, but the vaccine's protection wanes after about ten years, so they still need a booster shot if they are caring for children.

What's new here? First, there's a new report from an expert advisory panel to the Centers for Disease Control. The CDC panel is urging doctors to vaccinate everyone who might be in contact with young children, even if they can't remember when or if they had the pertussis vaccine. A report in the Journal of the American Medical Association this past week quotes pertussis expert Michael Brady, M.D., who chairs the American Academy of Pediatrics committee on infectious diseases, who says the new recommendations are needed as part of our efforts at "recontrolling pertussis."

What does Dr. Brady mean when he says "recontrolling"?Well, whooping cough is not under control right now.In California, a serious epidemic continues.(See my previous post about it here.) The CDC reports over 7,800 cases of pertussis throughout California, including the deaths of 10 infants.These infants were too young to be vaccinated, and their deaths are a tragedy that could have been prevented.The last time we saw this many cases of whooping cough in California was 63 years ago, in 1947.

Meanwhile, Michigan continues to have its own pertussis outbreak, with 1,092 cases this year, and 902 cases last year.And the pertussis epidemic has spread to Ohio, where two counties collectively report 910 cases this year, the largest number in 25 years.

In infants and very young children, pertussis causes violent, spasmodic coughing that repeats over and over.The cough is so strong that babies cannot breath properly, and after multiple coughs they will breathe in sharply with a classic "whooping" sound, which gives the disease its name.Pertussis is far more dangerous in infants than in adults: from 2000-2004, 92% of the pertussis deaths in the U.S. were in children less than one year old.

Whooping cough used to be under control.The number of nationwide cases was dropping for years, and although the disease didn't disappear, we were getting to the point where most people didn't know anyone who'd had it.The question is, why did we lose control?Is a new strain of pertussis to blame?Or is it our own behavior?

Unfortunately, the answer seems to be that these outbreaks are spreading as a result of falling vaccine rates, for which we can thank the anti-vaccine movement, which has been very effective at getting their message out through mainsteam media, including the Larry King show, Oprah, and The Huffington Post.One of the main groups in this movement is the mis-named National Vaccine Information Center, which really should be called the Vaccine Misinformation Center.Their pertussis web page contains a section titled "Can pertussis vaccine cause brain damage and death?"The mere act of asking this question is part of their anti-vaccine strategy.And rather than answering "no," the website goes on for several paragraphs, selectively quoting from studies that looked at vaccine risks - which are very small, but not zero - while ignoring the much greater risks of the disease itself.NVIC's website concludes by claiming (without citation) that

"Most pediatric neurologists acknowledge that vaccination, including use of vaccines for smallpox, rabies, influenza, mumps, measles, tetanus, polio and pertussis, can and does occasionally cause neurological complications that can lead to permanent brain dysfunction."

Scare tactics indeed.Not only is NVIC trying to scare parents away from the pertussis vaccine, but they take the opportunity to warn against many other vaccines.NVIC claims on its website that it "does not promote the use of vaccines and does not advise against the use of vaccines," but that, to put it bluntly, is a lie. Their primary mission is anti-vaccine advocacy, as illustrated by their current advertising campaign that claims we are "over-vaccinating" children and injecting them with harmful toxins.

So we can thank NVIC and other anti-vaccine groups, such as Generation Rescue (which claims, among many other mistaken notions, that the pertussis vaccine causes autism), for the re-emergence of whooping cough.

"Results from clinical trials showed that these vaccines are very safe for infants and children....The most common adverse events reported have been tenderness and redness where the shot was given, headache, diarrhea, and fussiness."

The current vaccine against whooping cough is called DTaP or TDaP (short for "tetanus toxoid, reduced diphtheria toxoid and acellular pertussis", and the evidence shows that it is very safe.The vaccine does not contain any whole cell, not even killed bacteria, meaning that it is impossible for the vaccine to cause even a mild case of any of the diseases that it protects against.

The CDC advisory on the pertussis vaccine is not part of a conspiracy to "over-vaccinate" the public, or to pad the profits of Big Pharma. (By the way, to pre-empt some of the commenters: I am not paid a single penny by any pharmaceutical company, nor am I paid by Forbes.) The advisory is a necessary step to "recontrol" whooping cough, a disease that we should not have let back into our communities.I fear that if we keep listening to the anti-vaccine activists, pertussis will be just the first in a series of diseases that will return to plague us, causing needless suffering and anguish.

All well and good to blame the unvaccinated - why is it that when those you term as anti-vax" question the side effects its scare tactics but when others throw around the potential worst case scenarios of whooping cough - that's informative?Its not the unvaccinated who are responsible for the up-tick in whooping cough - its been demonstrated that fully 2/3rds of the cases are in ALREADY vaccinated children.

Not only does the site appear to be fact based, not fear based, you are ignoring the fact that pertussis follows a cycle that includes outbreaks every 5 years or so, no matter how high the vaccination rate is. Additionally, have you checked to see how many of those who have contracted pertussis during these outbreaks are fully vaccinated? I hope that you will look for and publish all the facts instead of promulgating fear.

I'm sorry but I need to call bullshit. it has been shown that the current strain of pertussis may more than likely be a mutated more virulent strain and vaccination with the current shot wouldn't do a damn thing to help.

83 percent of the people with whooping cough in Fresno had been vaccinated. In San Luis Obispo, 76 percent were up to date on their immunizations. In San Diego, 68 percent were up to date.

Officials from the CDC, the California Department of Public Health and two pertussis experts from UCLA held a conference call Oct. 13 to discuss studying whether a more virulent strain was responsible for infant deaths and is contributing to the current epidemic.

Mooi said his research has been ignored by those who influence public policy on pertussis in the U.S. and beyond in part because they rely on vaccine makers to fund their meetings and research.

There is little incentive for pharmaceutical companies to pursue a new vaccine because it would cost billions, he said. The circulation of a more virulent strain of pertussis could mean a new vaccine should be created.

Freedom to choose! We all have different life experiences, beliefs, health, and opinions...the important things are education and FREEDOM to choose for our own. I once had a great doctor tell me, "You are the mother, YOU will know better than me if something is wrong with your child, use your motherly insincts" Motherly instincts have been replaced by doctors and scientists. Don't let FEAR make your choices... research, study, ask questions, pray, then make a choice with a calm heart. God is the ONLY one we can turn to for choices like vaxing or not. Only HE knows how it will effect our individual children.

This article is disjointed in its central conceit: that anti-vaccine advocacy is responsible for the return of pertussis. According to the author himself, the issue is most likely (or probably, or possibly) adults who were carriers.

I don't recall that the anti-vaccine movement has been targeting adults not to get vaccinated against pertussis.

Sounds like the author has an axe to grind about the anti-vax movement and is using the pertussis epidemic as a platform.

By the way, I am against vaccines (possible exception of rabies), and neither believe that it's a "conspiracy" nor that every pro-vaccine person is paid by Big Pharma. But it is reasonable to investigate the possible conflicts of interest that exist between those who stand to profit from drugs (including vaccines) and the government agencies that recommend or mandate them. And it is reasonable to ask whether we have developed a mindset that disease must be eradicated at all costs, such that every vaccine is welcomed with open arms and quickly mandated. It is reasonable to ask why, as the most highly vaccinated country in the world, we are one of the unhealthiest. And to ask why other countries have decided not to vaccinate as much as we have.

You see, people have the right to question what is put into our bodies, and what is mandated for the public health. We have a right to question the authorities. We have a right to review the science for ourselves, not simply to take the word of the CDC. And we have the right to use the media to warn others, much as the CDC and other government authorities use the media to warn about epidemics, or to warn about how anti-vaccine advocacy is to blame for epidemics.

most of the cases of pertussis now being seen are occuring in fully vaccinated children. Vaccines are poison and do not offer full protection against bacteria or viruses. Says so right in the ingredients and in the manufacturer's inserts. Don't be a drug company shill.

‎"Pertussis, an acute, infectious cough illness, remains endemic in the United States despite routine childhood pertussis vaccination for more than half a century and high coverage levels in children for more than a decade"

Sigh. These are predictable responses from various anti-vaccine advocates. I have heard them all before and it is hard to find time to respond to all, but here are a few quick responses. First, the deaths from pertussis in California were ALL in unvaccinated infants, too young to be vaccinated. Second, the vaccination rates in California and elsewhere have been declining rapidly, and public health experts have documented outbreaks of vaccine-preventable diseases that are indeed being spread by the unvaccinated. Third, vaccines are never 100% effective, so we need very high vaccination rates in order to develop "herd immunity": if enough people are protected, then an outbreak doesn't have a chance to spread.

To the commenter who claims this is all about "freedom" and "motherly instincts", I have two responses. First, our instincts are basically worthless when it comes to deciding whether a modern medical intervention will work. Second, if you live in society and not as a hermit, then your "freedom" has a very real impact on the health of others. I don't agree that people have the freedom to send their unvaccinated children to school with my (vaccinated) children - not only because vaccines are not 100% effective, but also for the sake of children and adults who cannot be vaccinated due to other serious health problems. I don't think it is reasonable to demand the "freedom" to spread disease.

Take a look at the pesticide/herbicide correlation should you really wish to learn something.

If vaccines are so great, there is no reason in the world my unvaccinated kid should affect your vaccinated kid. Seriously, how can you expect aspartame, mercury, formaldehyde, all known to be dangerous on their own, to be good for you when combined and injected directly into the body??? You can abuse your own kid if you wish, but don't tell me that I have to inject mine with poisons just because you do.

So Steven....when did you give yourself the title of GOD?. Brush up on your research in Medical Journals (and not the studies funded by big Pharma). I researched the topic for OVER a year before making my decision on whether or not to vaccinate my daughter. My conclusion was reached by my OWN accord based on THE FACTS. My conclusion is that there is no system of the human body, from mind to muscles to one’s immune system, which gets stronger through avoiding challenges, but only through overcoming challenges. Diseases exist, which is why God gave us an immune system to fend off any potentially harmful invaders. The lack of efficacy of vaccines indicates to me that vaccines are still an unproven THEORY, especially given that viruses are constantly mutating to survive. My research (mostly through Medical journals) led me to the conclusion that injecting formaldehyde, mercury, aluminum, paint thinner, coolant, anti-freeze, detergent, phenols, MSG, dead animal tissue, aborted fetal tissue, mutated human and animal viruses, bacteria, antibiotics and animal, bacterial and viral DNA, poly sorbate 80, ETC... is not particularly a good idea. Get off your soapbox and get your facts straight.

Here's a thought...vaccinated people Have been injected with the diseases, therefore are carrying some sort of dead or alive 'germs' within their bodies...UnVaxed people can NOT run around spreading these diseases unless they come in contact with the disease from a carrier. I don't understand why people like Steven appear to think that non-vaxed children are carriers of the diseases when they are NOT the ones injected with them!

"I don't agree that people have the freedom to send their unvaccinated children to school with my (vaccinated) children - not only because vaccines are not 100% effective, but also for the sake of children and adults who cannot be vaccinated due to other serious health problems."...This statement is interesting. There are MANY diseases out there and MANY of them have no vaccine to 'protect' us...so really vaccinated or not, we are not safe. Maybe we should all become hermits...

I'm proud to say that I am one of those "anti-vax" parents that your talking about. However, that was not always the case. All of my children were vaccinated on schedule and I even stayed on my older children to have the grand babies vaccinated until my 5th child received his 24 month combo shot and within weeks had regressed from a bright, happy chatterbox to a completely non-verbal, head banging emotional wreck. Within months he was diagnosed as autistic and I began doing research to help find answers. I've also realized that his 4 year old brother who was a calm, mild tempered happy infant and toddler became loud, hyperactive, anxious and easily overstimulated shortly after his 24 month injectionsI don't believe that vaccines were solely responsible for my son's regression, but I am certain they were a trigger. Therefore, we immediately stopped all immunizations. My 4 year old is currently up to date because he had already received all his shots when we quit. The 3 year old who was diagnosed with autism is 2 sets behind and the 2 year old only received the HepB that was given in the hospital when he was born.That being said, since we have quit vaccinating the boys have been the picture of health and have had no colds or flus with the exception of the 4 year old (fully vaccinated) who developed a mutated strain of pertussis last spring. Neither of the other two boys caught it and the 4 year old weathered it in just 4 or 5 days.While pertussis is a very dangerous disease for very small babies and children, the deaths associated with it are just a fraction of the deaths and injuries contributed to vaccine reactions and I feel like my children have a better chance relying on their own healthy immune system than bypassing the immune system completely by injecting them with toxic chemicals and live viruses that their body hasn't been given the chance to fight or repel.

Christy, I've written about vaccines and autism before, and read extensively on the topic. The evidence is overwhelming that vaccines do not causes autism, nor do any of the ingredients in them. Autism is a serious disease that manifests itself in early childhood, right around the time that children are getting vaccinated. It is inevitable that many children will first be diagnosed (or signs will be noticed by their parents) just after being vaccinated, merely by chance. Your son apparently was one of those. Correlation is not causation, and in this case, the question has been studied very, very thoroughly. There are many ongoing studies of autism, some of which I am following, and it is a complex disease that certainly needs more study and research. However, vaccinations have nothing to do with it, and focusing on this disproven link only distracts energy and funds that should be invested in figuring out the real causes of autism.

I understood from random google search results that I cannot replicate (sigh) that pertussis had a really high fatality rate in newborns, which is why we're practicing cocooning with our 1 mo old. Either way, sounds like something we don't want her to get.

Anyway, Steve, I'm curious about the high rate of infection amongst people that have received the current vaccination; this story

suggests that perhaps there's a newer, more virulent form of pertussis going the rounds. From your response above to others, it sounds like you believe that the vaccine is simply not very effective. Do you have any more information on this? I was curious about what the numbers of infections implied about the effectiveness of the vaccine.

I have two children and before deciding whether to vaccinate them or not I have researched the topic extensively. What have I found? On one side - fearmongering, baseless accusations and general preference for anecdote over data. On the other - discussion of the relevant research and honest exposition of risks associated with the decision. Of course I vaccinated my kids.The truth really is out there - if you read the research papers, not sensational articles.

Titus: the pertussis vaccine has an effectiveness of around 92% (see this study in the New England Journal of Medicine from 2005: http://www.nejm.org/doi/full/10.1056/NEJMoa050824). However, it fades rapidly after 10 years. This is one reason why we keep getting outbreaks, according to an earlier study - we don't have herd immunity as the protection fades in older teens and adults. This also explains the reasoning behind the new CDC recommendation that many more people get booster shots.

There may indeed be a more virulent form of pertussis going around, but the vaccine should still protect against it.

Yes, the information is out there, and that is exactly why we are done with vaccines. We still read 'sensational' articles such as this, to make sure we get the 'industry view'. To see what kind of vaccines that are in the pipeline and endorsed by people like you... Smoking vaccine anyone? Fat vaccine?? Vaccines for anything and everyone!!! Seriously? It's time for the medical community to sell their stocks in Merck and friends and truly live up to their oath. BUT, money always wins, just be sure you keep your infected kids(when was your last vaccine??) away from mine.

Spence, have you acually tried to get your head around the why and how the vaccines work? Or are you just listening to the loudest screaming voices and your deepest fears?For your conspiracy scenario to be plausible, all the scientists in all the countries of the world would have to be bribed or otherwise silenced, even in the former communist bloc (I'm from there and I was vaccinated in my childhood) and countries like Cuba.

Most vaccines even state in the insert all the dangers, and efficacy rate. Read up, I know my folks doctor did, and guess what, he refuses to give shots now... amazing that..

Even the CDC says they don't work, yet their answer is to vaccinate even more. (So throwing gas(adjuvants and other bs ingredients, msg, aspartame, mercury, antifreeze etc.) on a fire didn't put the fire out, so yes, we must use more gas!) In case you missed this from above....

"Pertussis, an acute, infectious cough illness, remains endemic in the United States despite routine childhood pertussis vaccination for more than half a century and high coverage levels in children for more than a decade" The CDChttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm

If vaccines are so great, how is it the the people taking them have no right for compensation if it causes damage?

Have you seen all the damage being done by the HPV vaccine? Why have countries already banned it? Conspiracy theory?? If you say so.. I disagree, but believe you have every right to participate in this illusion.

Why is it that most people I know that get sick every year always get their flu shots? I have never had one, and amazingly never get sick. Since my folks quit getting their flu shots, they too don't get sick anymore. Could it be my diet? Does what you consume affect your health? Nah, must be conspiracy theory.

All vaccines don't work because CDC warns that the pertussis vaccine gives you "only" 10 years immunity and then you need a booster shot?Your lack of logic is showing.People have every right to compensation if the vaccine causes damage to them. In the US they even don't have to prove it - they have just to prove it MIGHT have caused damage. I'm from Poland and I know it.Oh, you mean that people should have the right to compensation if they are run over by a lorry after vaccination? Or turn autistic? Good luck with that in ANY country in the world. The vast international conspiracy of children-hating pediatritians took care of it (they all hate children, that's why they get the specialization - to stick the needles in kids).And especially for you - the last paragraph contains not insignificant amount of irony

Some of you have probably seen this story:http://news.yahoo.com/s/ap/20110106/ap_on_he_me/eu_med_autism_fraudlink to British Medical Journal:http://www.bmj.com/content/342/bmj.c5347and editorial by the editor in chief:http://www.bmj.com/content/342/bmj.c7452I sometime wonder what the world would be like if Wakefield had never committed this fraud...it is in the same line of other criminals that changed the lives and the history of way too many of us...and also caused unneccessary death. I believe that without his fraudulent article this whole debate would have never happended...It's one of those what if scenarios - like what if Gorbachev had not started to open up the former Sowjet Union to the West...what if this criminal Wakefield had not disguised himself as a responsible physician/scientist...

Thank you for the reminder. My husband and I need to get our pertussis boosters before our child is born in a month.

We are actually having a hard time finding a pediatrician in our area who refuses to see anti-vaxers. No way in hell, though, am I bringing a vulnerable newborn who is too young for her vaccines into an office full of unvaccinated kids.

Anyway, keep up the good work. I don't know if it will do much good in the short term, since the anti-vax people are so stubbornly immune to evidence and logic, but it is still worth fighting this fight.